Provider Demographics
NPI:1265847149
Name:OBADIYA, OLALEKAN PATRICK (NP)
Entity Type:Individual
Prefix:MR
First Name:OLALEKAN
Middle Name:PATRICK
Last Name:OBADIYA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1210 COUNTY ROAD J
Mailing Address - Street 2:STE 102
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55127-6826
Mailing Address - Country:US
Mailing Address - Phone:651-235-7704
Mailing Address - Fax:612-454-2340
Practice Address - Street 1:3329 UNIVERSITY AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-3325
Practice Address - Country:US
Practice Address - Phone:612-454-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR153974-5363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner